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Fentanyl-laced cocaine is Ohio's newest killer - but we can combat this scourge: Dennis Cauchon (Opinion)

Updated January 19, 2018 at 8:58 AM;Posted January 19, 2018 at 5:54 AM

The late Jennifer Ayars with her father Bill during a family trip. Jennifer Ayars, of Bay Village, Ohio, died in February 2016 of a cocaine and fentanyl overdose, leading her parents to establish the Emerald Jenny Foundation in her honor to help others struggling with addiction. Guest columnist Dennis Cauchon writes that cocaine-fentanyl combinations are the newest killers in Ohio.(Ayars family photo)

Dennis Cauchon, a former reporter, is president of Harm Reduction Ohio, a drug policy reform group he funds.

GRANVILLE, Ohio -- Fentanyl has started killing cocaine users in Ohio at a faster pace than the death toll for heroin. The drug's movement into the cocaine supply is an enormous public health threat and likely will cause another record overdose death toll in Ohio in 2017 when all data are in, and possibly 2018. Far more Ohioans use cocaine than use heroin.

The shift in who's dying and what drug is carrying fentanyl or one of its many variants has gone unnoticed in Ohio's massive response to drug overdoses, which erroneously treats fentanyl as super-strong heroin. It is not.

Fentanyl is an all-purpose additive to illegal drugs: a compact, smuggler-friendly, potency boost.

Fentanyl is primarily an economic phenomenon, not a medical one. The drug's spread is the marketplace's response to law enforcement and regulatory policies that have cracked down on prescription opioids, domestic meth labs and growing coca and opium plants, which are grown outdoors, visible by satellites and drones.

Consumer demand isn't great for fentanyl. It's an old drug available, legally and illegally, for more than a half century. Fentanyl produces less euphoria than heroin and a feeling contrary to what cocaine and meth users want. Fentanyl's only advantage? It's easy to hide.

Fentanyl and its variants are now everywhere in Ohio's illegal drug supply, except marijuana and psychedelic mushrooms. If the fentanyl epidemic was just a case of an "opioid gone wild," it wouldn't be in cocaine, meth, Ecstasy, LSD and fake pills, including stimulants. And this many cocaine users wouldn't be dying.

Fentanyl's spread in cocaine is seen in Ohio's autopsy results. The change started in 2015 -- slightly trailing what happened to heroin -- then accelerated in 2016 and reached a tipping point in 2017. Last year, fentanyl-cocaine overdose combinations far outnumbered those for heroin.

In the 3,480 Ohio overdose autopsies reported to the state as of this writing, 757 of the fatalities were for cocaine and fentanyl versus 476 for heroin and fentanyl. Heroin deaths are actually falling for a variety of reasons, such as naloxone and users taking smaller doses as a safety precaution.

Cuyahoga County is an example of cocaine's new lethality. The county reported 382 cocaine users died through October, up from 260 in 2016 and 115 in 2015 . By contrast, overdoses involving heroin fell 16 percent to 269 through October.

In my view, Ohio must take its blinders off and rethink what's causing overdoses. The overdose epidemic is not a heroin or even opioid problem. It's a problem of a contaminated illegal drug supply. That's why trying to arrest and regulate our way out of this will only make things worse.

How can we turn things around without taking on the lightning-rod issue of drug prohibition?

First, work with active drug users to prevent overdoses before they occur. Reviving drug users with naloxone is good but preventing overdoses in the first place is even better.

For safety, drug users must know what's in illegal drugs. Let's start with cocaine. Cocaine users don't want fentanyl at all, not even as a second choice (as a heroin user might). Help them reject fentanyl-laced cocaine, an unexpected and undesired combination that kills many, including a 23-year-old campaign aide to Gov. John Kasich in June.

Ohio can help users prevent fentanyl overdoses inexpensively by doing three things:

Distribute fentanyl test strips. These tests, based on the same principle as pregnancy tests, use lines to show fentanyl's presence. Other states already provide these tests to users. They cost $2 to $3 per test online and would be cheaper bought in bulk. County health departments should distribute tests strips widely, as they do now for naloxone at about $100 per dose.

Publicize drug seizure lab results. Ohio's crime labs test thousands of drug seizures every year but don't release the information to the public. This secrecy must end. With tens of thousands of overdoses and 4,000-plus deaths a year, the public must be given facts on drug combinations and contamination. Drug seizure lab analysis is a public health asset going to waste. Lab results should be published online daily.

Publicize health warnings. State and county health departments should issue public health alerts about the presence of fentanyl in cocaine, a step taken this week in Columbus.

Knowledge is power. In this case, it's the power to save lives by providing information to help users better understand what they're consuming.

Dennis Cauchon, a former national reporter for USA Today, is the president of Harm Reduction Ohio, a drug policy reform group, which he funds from his savings.

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